Abstract
Introduction
Calls for reform of medical education encourage early integration of clinical medicine into the pre-clerkship curriculum, traditionally the domain of basic science. It is not known whether this early integration helps students develop clinical reasoning.
Methods
As part of a comprehensive curriculum reform, our medical school instituted strategies to integrate basic science and clinical skills within a shortened pre-clerkship curriculum. We introduced “clinical correlations,” interactive lectures teaching a clinical skill by introducing a patient with a disease process students are studying in science. We connected the standardized patient environment and authentic clinical environment by ensuring longitudinal mentoring relationships in both settings. We adopted an integrated assessment structure for the pre-clerkship phase. To assess the effects of these innovations, we examined students’ perceptions of their clinical reasoning skills and assessed evaluations of clinical reasoning tasks in early clerkships.
Results
Compared to the traditional curriculum, students in the integrated curriculum felt significantly better-prepared for six of seven clinical reasoning tasks, and they felt more clinically prepared overall. Students in both curricula received high ratings from clerkship directors for skills related to clinical reasoning, with no significant difference seen between the two groups on any clerkship.
Conclusion
Our findings suggest that integrated basic science-clinical medicine curricula can improve student confidence in clinical reasoning. While the lack of improvement in clerkship director ratings could relate to poor sensitivity of these measures to detect changes in skills, further modification of the curriculum may be needed to impact student performance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cooke M, Irby D, O’Brien BC. Educating physicians: a call for reform of medical schools and residency. San Francisco: Jossey-Bass; 2010.
Yardley S, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V, et al. What has changed in the evidence for early experience? Update of a BEME systematic review. Med Teach. 2010;32:740–6.
Dornan T et al. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28:3–18.
Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006;355:2217–25.
Association of American Medical Colleges. Recommendations for pre-clerkship clinical skills education for undergraduate medical education. 2008. (https://www.aamc.org/download/163788/data/recommendations_for_preclerkship_skills_education_for_ugme.pdf) Accessed 14 May 2015.
Association of American Medical Colleges. 2014. Core Entrustable professional activities for entering residency curriculum developers’ guide https://members.aamc.org/eweb/upload/Core%20EPA%20Curriculum%20Dev%20Guide.pdf Accessed 14 May 2015.
Woods NN. Science is fundamental: the role of biomedical knowledge in clinical reasoning. Med Educ. 2007;41:1173–7.
Jacobson K, Fisher DL, Hoffman K, Tsoulis K. Integrated cases section: a course designed to promote clinical reasoning in year 2 medical students. Teach Lear Med. 22, 312–316.
Schmidt HG, Machiels-Bongaerts M, Hermans H, ten Cate TJ, Venekamp R, Boshuizen HP. The development of diagnostic competence: comparison of a problem-based, an integrated, and a conventional medical curriculum. Acad Med. 1996;71:658–64.
Diemers AD, Dolmans DH, Verwijnen MG, Heineman E, Scherpbier AJ. Students’ opinions about the effects of preclinical patient contacts on their learning. Adv Health Sci Educ Theory Pract. 2008;13:633–47.
Makoul G, Curry R. Patient, physician & society: Northwestern University Medical School. Acad Med. 1998;73:14–24.
Evans DB. The patient-centered medical home as a curricular model: medical students need an “educational home.”. Acad Med. 2011;86:e2.
Gable RK, Wolfe MB. Instrument development in the affective domain: measuring attitudes and values in corporate and school settings. Boston: Kluwer Academic Publishers; 1993.
Yardley S, Dornan T. Kirkpatrick’s levels and education ‘evidence’. Med Educ. 2012;46:97–106.
Radcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. Med Educ. 2003;37:32–8.
Hayes K, Feather A, Hall A, Sedgwick P, Wannan G, Wessier-Smith A, et al. Anxiety in medical students: is preparation for full-time clinical attachments more dependent upon differences in maturity or on educational programmes for undergraduate and graduate entry students? Med Educ. 2004;38(11):1154–63.
Wingelaar TT, Wagter JM, Arnold AE. Students’ educational needs for clinical reasoning in first clerkships. Perspect Med Educ. 2012;1:56–66.
Kulasegaram KM, Martimianakis MA, Mylopoulos M, Whitehead CR, Woods NN. Cognition before curriculum: rethinking the integration of basic science and clinical learning. Acad Med. 2013;88:1578–85.
Acknowledgments
The authors wish to acknowledge the contributions of Clare Petrie, coordinator of the clinical medicine element of the integrated curriculum, for her role in implementation, and Drs. John X. Thomas and Diane B. Wayne for their valuable input and editing of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Heiman, H.L., O’Brien, C.L., Butter, J. et al. Ready to Reason: Integration of Clinical Education and Basic Science Improves Medical Students’ Self-Assessed Clinical Reasoning Before Clerkships. Med.Sci.Educ. 25, 513–519 (2015). https://doi.org/10.1007/s40670-015-0181-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40670-015-0181-z